Urinary Tract Infections (H@H)

Length of treatment: 3 days in women, 7 days in men

Nitrofurantoin 100mg MR orally every 12 hours

• Not for systemic symptoms (e.g. fever, shaking, chills, palpitations), upper UTI, or patients with raised inflammatory markers
• Use alternative drug if suspension required (due to prohibitive cost)
• If eGFR 30-45 ml/min use with caution for short course. Do not use if eGFR<30 ml/min
• Be alert to risks of pulmonary and hepatic drug reactions - see MHRA warning 2023

OR

Pivmecillinam initially 400 mg for 1 dose, then 200 mg orally every 8 hours 

(Note: is a penicillin).

Alternative, if known trimethoprim susceptible isolate.

Trimethoprim 200mg orally every 12 hours

(see Appendix 1 for dose reduction in renal impairment)

Alternative in penicillin allergy and eGFR 10-30ml/min

Fosfomycin 3g STAT dose oral (prescribe as Monuril®) [repeat after 72 hours in men – total of 2 doses].

• Dose at night after emptying bladder

Alternative if unable to use above options

Cefalexin 500mg oral every 12 hours, women 3 days, men 7 days

Note: is a first generation cephalosporin

Length of treatment: 7 days

Gentamicin intravenous: use NHS Lothian online calculator.

• Review after 48 hours of IV therapy and switch to oral if symptomatic improvement
• Gentamicin should not be extended for more than 72 hours in H@H patients without advice from an infection specialist, consideration of toxicities and monitoring. (Note this differs from advice for patients in acute care settings where up to 5 days may be given)
• Oral switch based on MSU result where available [do NOT use nitrofurantoin, pivmecillinam, or fosfomycin]
• If culture results not available review urine results in previous year; if no trimethoprim resistant isolates then consider co-trimoxazole

Do not use urine dipstick to diagnosis catheter associated urinary tract infection

Urine culture is often positive in catheterised patients; this does not differentiate between colonisation and infection

Catheter associated urinary tract infection is diagnosed clinically

Catheter associated urinary tract infection diagnosis is based on the following:

• Temperature >38^oC (this may be absent in older patients)
• No evidence of focus of infection elsewhere
• Any of the following signs or symptoms:
  • Rigor
  • Supra-pubic or flank pain
  • Frank haematuria
  • Delirium

Review the need for the catheter – consider permanent removal

If catheter has been in for >7 days and cannot be permanently removed change the catheter (within 24 hours of starting antibiotics).

Obtain a urine sample before antibiotics are taken.

Take the sample from the catheter via a sampling port (using aseptic technique).

If the catheter has been changed take the sample from the new catheter.

If the catheter has been removed obtain a midstream specimen of urine.

Contact Microbiology for advice if gentamicin resistance in urinary isolates within last 6 months.

Gentamicin intravenous as per NHS Lothian online calculator stat dose

AND catheter change

Assess need for ongoing oral therapy.